Endometrial Cancer Staging, Molecular Classification and Adjuvant Therapy

A 52-year-old postmenopausal woman presents with postmenopausal bleeding and pelvic pain. Transvaginal ultrasound shows an endometrial mass with myometrial invasion up to the inner third. MRI confirms FIGO stage IB endometrial cancer. She undergoes total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection. Histopathology reveals grade 2 endometrioid adenocarcinoma with lymphovascular space invasion (LVSI). Pelvic lymph nodes are negative. Which of the following is the most appropriate adjuvant treatment?

A 48-year-old woman with a 10-year history of unopposed estrogen exposure (due to anovulation) presents with abnormal uterine bleeding. Endometrial biopsy confirms grade 2 endometrial adenocarcinoma. She is counselled about risk factors and treatment options. Which of the following molecular alterations is MOST commonly associated with this type of endometrial cancer and has implications for prognosis and targeted therapy?

A 62-year-old woman from Mumbai presents with postmenopausal bleeding. Endometrial biopsy shows grade 3 serous adenocarcinoma. She undergoes staging laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, and omentectomy. Pathology reveals tumor confined to the endometrium (no myoinvasion), 2 of 8 pelvic lymph nodes involved, and no para-aortic node involvement. Molecular testing shows p53 mutation with wild-type PTEN and no MSI. Final stage is IIIC1 (pelvic node metastases). What is the most appropriate adjuvant therapy?

A 58-year-old postmenopausal woman from Delhi presents with abnormal uterine bleeding for 3 months. Pap smear is normal. Transvaginal ultrasound shows an endometrial thickness of 18 mm with a heterogeneous mass. Endometrial biopsy confirms grade 2 endometrioid adenocarcinoma. She undergoes total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Pathology reveals invasion into the inner half of the myometrium, no lymph node involvement (0/15 pelvic nodes), and no distant metastases. Molecular testing shows microsatellite instability (MSI-high) with PTEN loss. What is the most appropriate adjuvant therapy?

A 62-year-old woman from Bangalore undergoes total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection for endometrial cancer. Final histopathology shows grade 3 endometrioid adenocarcinoma with deep myometrial invasion (>50%) and 2 out of 15 pelvic lymph nodes positive for metastatic disease. Immunohistochemistry reveals loss of MLH1 and PMS2 expression (intact MSH2 and MSH6). Molecular testing confirms microsatellite instability-high (MSI-H) status. There is no evidence of distant metastases. According to current NCCN and ESMO guidelines, what is the most appropriate adjuvant treatment strategy?